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Lee and Song: Symptom Management to Predict Quality of Life in Patients with Heart Failure: A Structural Equation Modeling Approach
Original Article

J Korean Acad Nurs 2015;45(6):846-856.

Published online: 15 December 2015

DOI: https://doi.org/10.4040/jkan.2015.45.6.846

Symptom Management to Predict Quality of Life in Patients with Heart Failure: A Structural Equation Modeling Approach

Ja Ok Lee1, Rhayun Song2,

1The Catholic University Daejeon St. Mary's Hospital, Daejeon

2College of Nursing, Chungnam National University, Daejeon, Korea

Address reprint requests to : Song, Rhayun College of Nursing, Chungnam National University, 266 Munwha-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-580-8331 Fax: +82-42-584-8915 E-mail: songry@cnu.ac.kr

Received 11 May 2015       Revised 20 May 2015       Accepted 12 August 2015

Copyright © 2015 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The focus of this study was on symptom management to predict quality of life among individuals with heart failure. The theoretical model was constructed based on situation-specific theory of heart failure self-care and literature review.

Methods

For participants, 241 outpatients at a university hospital were invited to the study from May 19 to July 30, 2014. Data were collected with structured questionnaires and analyzed using SPSSWIN and AMOS 20.0.

Results

The goodness of fit index for the hypothetical model was .93, incremental fit index, .90, and comparative fit index, .90. As the outcomes satisfied the recommended level, the hypothetical model appeared to fit the data. Seven of the eight hypotheses selected for the hypothetical model were statistically significant. The predictors of symptom management, symptom management confidence and social support together explained 32% of the variance in quality of life. The 28% of variance in symptom management was explained by symptom recognition, heart failure knowledge and symptom management confidence. The 4% of variance in symptom management confidence was explained by social support.

Conclusion

The hypothetical model of this study was confirmed to be adequate in explaining and predicting quality of life among patients with heart failure through symptom management. Effective strategies to improve quality of life among patients with heart failure should focus on symptom management. Symptom management can be enhanced by providing educational programs, encouraging social support and confidence, consequently improving quality of life among this population.

Keywords: Heart failure, Symptom, Management, Quality of life

References

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Figure 1.
Model of heart failure self-care [2].
jkan-45-846f1.tif
Figure 2.
Path diagram of the hypothetical model.
jkan-45-846f2.tif
Figure 3.
Path diagram of the hypothetical model including control variable.
jkan-45-846f3.tif
Table 1.
Fit Index of the Hypothetical Model
Model χ2 DF p χ2/df GFI SRMR RMSEA IFI CFI
Evaluation criteria − − > .05 <3 ≥.90 ≤.05 ≤.10 ≥.90 ≥.90
Hypothetical model 88.15 29 < .001 3.04 .93 .06 .09 .90 .90

GFI=Goodness of fit index; SRMR=Standardized root mean residual; RMSEA=Root mean squared error of approximation; IFI=Incremental fit index; CFI=Comparative fit index.

Table 2.
Direct Effect, Indirect Effect, and Total Effect in Hypothetical Model (N=241)
Endogenous variables Exogenous variables Hypothetical model
 Direct effect
 Indirect effect
 Total effect
SRW (SE) C.R (p) SMC p p p
SM confidence Social support .20 (.04) 3.23 (.001) .04 .20 (.004) .20 (.004)
Symptom S recognition .34 (.13) 6.08 (.001) .28 .34 (.021) .34 (.021)
management HF knowledge .23 (.07) 4.05 (< .001) .23 (.003) .23 (.003)
SM confidence .24 (.04) 4.24 (< .001) .24 (.008) .24 (.008)
Social support .04 (.02) 0.64 (.525) .04 (.676) .05 (.004) .09 (.116)
Quality of life S recognition .32 .09 (.007) .09 (.007)
HF knowledge .06 (.002) .06 (.002)
SM confidence .30 (.05) 4.51 (< .001) .30 (.008) .06 (.004) .37 (.016)
S management .26 (.07) 4.02 (< .001) .26 (.009) .26 (.009)
Social support .26 (.03) 4.01 (< .001) 26 (.007) .08 (.003) .34 (.010)

SRW=Standardized regression weight; C.R=Critical ratio; SMC=Squared multiple correlation; HF=Heart failure; SM=Symptom management; S=Symptom.

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